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C <br /> Ri�r$ COLORADO DIVISION OF MINERALS AND GEOLOGY <br /> 6 x 1313 Sherman Street,Room 215,Denver,Colorado 80203,(303)866-3567 <br /> APPLICATION FORM FOR A REVISION <br /> TO A COAL MINING AND RECLAMATION PERMIT <br /> This form must be completed and submitted with all requests for minor revisions, as defined in Rule 1.04(73), <br /> technical revisions, as defined in Rule 1.04(136), and permit revisions, as defined in Rule 1.04(90). All revisions <br /> are to address the requirements of Rule 2.08.4. Three (3) copies of the revision, including maps, must be <br /> submitted in order for it to be complete. <br /> All revisions are to be formatted so they can be inserted into the permit to replace the revised sections, maps, <br /> tables and/or figures, with a revised table of contents, if necessary. The revision submittal date should be printed <br /> in the lower right corner of each revision page. A cover letter to the revision should explain the nature of the <br /> revision and reference the specific permit sections being revised. <br /> For federal mines, a copy of the revision application must be submitted to all agencies on the federal mailing list <br /> (except OSM) at the same time the application is submitted to the Division, and proof of distribution must be <br /> submitted to the Division along with the application. Copies of revision pages modified during the review process <br /> must be distributed in the same manner, along with proof of distribution. Proof of distribution must be submitted <br /> prior to implementation of the revision. <br /> Permit No.: C - 1981 - 018 Date: 4 / 27 / 2022 <br /> Permittee: Blue Mountain Energy, Inc. <br /> RECEIVED <br /> Street: 3607 CR 65 <br /> MAY 0 � 2012 <br /> City: Rangely DIVISION RECLAMATIC'N' <br /> g <br /> State: Co Zip Code: 81648 _ MINING& P.FETY'MINERAI"3 <br /> Brief Description of Revision: TR-74: Combination of Refuse Piles RP-2/3/4 <br /> and RP-5A. <br /> Public Notice Attached: Yes ✓ No . (Required for PRs and TRs) <br /> Bond Increase: Yes ✓ No_ Federal ✓ Non-Federal _ Mine <br /> Proposed Change in: <br /> Permit Area - Surface Ownership - <br /> Disturbed (+/-)_ _ 5. 83Acres Private Land (+/-)_ _ _ —Acres <br /> Permit (+/-)_ _ 0 . 0 Acres Federal Land (+/-)_ _ _ . —Acres <br /> Affected (+/-)_ _ 0. 0 Acres State Land (+/-)_ _ _ —Acres <br /> Mineral Ownership - <br /> Mineral Private (+/-) _ _ _ _Acres Mineral State (+/-)_ _ _ . —Acres <br /> Mineral Federal (+/-)_ _ _ . —Acres <br />